Mentally ill hit hardest by national anxiety

Terrorism is stressful for the most balanced among us. Its effect on those already coping with mental illness can be life-altering. And aid is in short supply.

By ABIGAIL TRAFFORD

© St. Petersburg Times,
published November 6, 2001

At a recent gala Washington dinner to celebrate advances in brain research, Lydia Lewis found herself at a table with the cream of the medical-political establishment -- members of Congress, health officials, university chairs. Lewis was in her element. As director of the National Depressive and Manic-Depressive Association, she bantered her way through an evening of fine food and important talk.

But something was going on inside that no one could see. "I am having difficulty coping," says Lewis, who suffers from bouts of severe depression and a milder chronic depression.

"I'm having a great deal of trouble focusing. I'm very fragmented. I'm feeling hopeless. I'm extremely tired. All I want to do is sleep."

Although her passion is travel -- she has been to Cambodia, the Sinai and New Zealand and has plans for a trip to Malta -- "I don't want to go. There's no energy to do anything," she says.

These are the classic symptoms of depression, and Lewis knows that. She also knows where to go for help and how to take care of herself. After all, she drew up tips for the general public on how to cope in the wake of the terror attacks.

With Americans under siege from threats of bioterrorism, people with psychiatric illness are on the front lines of what is now a national anxiety attack. For all the terror and confusion that has descended on the "normal majority," the assault is greater on those with mental illness.

They already know what it's like to be afraid and despairing, bewildered and jumpy. That's the natural order when your mental ZIP code includes schizophrenia, depression, anxiety or post-traumatic stress disorder. Not all the time, and not if you get proper care. But you've seen the dark side of the mind; stress is a constant companion.

"I just basically lost it," says Brian Coopper, senior director of consumer advocacy at the National Mental Health Association in Alexandria, Va. Right after the Sept. 11 attacks, he suffered a second blow. A close friend died of cardiac arrest. As he sat in the church at her funeral, he looked at her husband and children and grandchildren sitting in the front row. Then it hit him: 5,000 funerals going on for those killed in the attacks. All the loss, all the grieving.

Then came the government warnings to expect another terrorist attack. That did it. He told the staff: "I'm taking some days off. I'm not sure when I'll be back." He describes it as "my own little Martin Sheen breakdown" after the scene in Apocalypse Now.

But Coopper, diagnosed years ago with depression, also knows how to take care of himself. He immediately contacted his psychopharmacologist to give him a prescription for sleep medication. He got on the phone with his support group of friends and colleagues. He started using the chain lock in addition to the dead bolt on his apartment door to give him "a tiny piece of security," he says. "We're all craving security right now." He stopped watching the news, stopped listening to National Public Radio while taking a shower. Instead he got out his folk-rock CDs, music he associated with better times.

"I want to minimize my exposure. I'm already feeling it enough," he says. "I want to push myself into the ignorance zone."

After a few days he went back to work.

"I've had a couple of bad days," echoes Robin S. Cohen, a group leader at Peer Place, a drop-in counseling center run by the Mental Health Association of Palm Beach County. Cohen has manic-depressive illness with a secondary diagnosis of anxiety. The attacks of Sept. 11 left her nauseated. She couldn't swallow. She has lost 15 pounds and can only manage one meal a day. Her face broke out in pimples. She didn't want to get up in the morning. "I'd cry indiscriminately," she says -- a burst of tears when she'd be driving on I-95 or shopping.

She got a little paranoid, too. After all, she lives two towns away from the Florida man who died of anthrax. Right across the street is the airport where one of the terrorists took flying lessons. "I always think there are terrorists milling around," she says.

"I became extremely manic along with anxiety. That's when your anger is at its peak," she continues. "Mania is a really tough part of my disease. You drive recklessly, you throw out unkind comments. You say: Why is this happening to me? Why not in South America? They deserve it more. Everything is everybody else's fault. The anxiety doubles when you're mad."

One thought jumping to another and another, faster and faster. This is how the mind spins out of control. Cohen knew it was happening -- and she dealt with it. She got a prescription for a tranquilizer in addition to the 18 pills she takes every day for her depression. She went to her therapist for counseling. She turned to her mom. She got help from her colleagues. Her supervisor gave her "a good talking to," she says, to help her get some perspective.

Now she can say: "You can't always control everything. I could open an envelope of anthrax, or I could get run over by a train."

Lewis, Coopper and Cohen are the lucky ones. They have access to medical treatment and support services. They have jobs and safe places to live. They have social networks of friends, colleagues, family and peers.

But many people with mental illness are not so lucky. The majority of people with schizophrenia, for example, do not receive the treatment and support they need, according to the 1999 Surgeon General's Report on Mental Health. Nearly 40 percent of those with bipolar depression go without treatment in a given year. There aren't enough child and adolescent psychiatrists to treat the estimated 5 percent of all children who experience "extreme functional impairment." The elderly are often forgotten, yet 20 percent of people over 55 have mental disorders that are not related to aging.

The state of mental health care is "abysmal," says Coopper.

It is almost a cruel joke that the 1996 Mental Health Parity Act expired on Oct. 1. A new and improved bill to make sure mental health coverage in group plans is on a par with medical and surgical benefits was unanimously passed by the Senate Committee on Health, Education, Labor and Pension before the terror attacks. The bill has 64 cosponsors and remains a high priority for Sen. Pete V. Domenici, R-N.M., a long-time advocate of mental health services.

But the only health programs that are getting congressional attention these days are those aimed at increasing stockpiles of Cipro or vaccines against smallpox. That leaves millions of Americans with mental illness without a safety net.

Meanwhile, the suffering escalates among those most vulnerable. In Pittsburgh, an elderly woman with depression was so overwhelmed by television images that she thought firefighters and the president were in her home. On an American Airlines flight to Chicago, a man stormed the cockpit because he thought the plane had been hijacked and was heading for the Sears Tower. He had been diagnosed with mental problems the week before and was not taking medication, according to news reports.

In support groups across the country, attendance is up, mental health activists report. At meetings for people with depressive disorders in Boston, the number of newcomers doubled after Sept. 11. Those in treatment have experienced a worsening of symptoms.

"People who have a delusional or paranoia aspect of their disease -- it has been very difficult for them," says Everett Page, a group leader in Boston who has depression. In Iowa, about 10 people in a depressive and manic-depressive association checked into the hospital because they were cycling into a manic phase -- a higher than usual number.

Cohen describes the mood in her Florida group. "People with paranoid schizophrenia think that the government is plotting against them anyway. They feel they are going to be targeted with anthrax, that the government is planting anthrax throughout the area."

Those with depression have a different response. "They don't want to talk about it. They aren't ready to express how they feel. They want to go home and get into bed. They don't want to shop or shower," she says. "They are ready to get anthrax and die. It enables them to think that they don't have to do the job themselves."

So much pain. Sept. 11 has focused public attention on mental health. This is not to make a pathology out of the national mood of anxiety. Most people with the jitters will not develop post-traumatic stress disorder. But the line between normal and abnormal can get blurred in times of crisis. Those who were directly affected by the attacks -- the thousands of children who lost a parent, for example -- are at heightened risk. Without access to treatment and support, many Americans are in danger of a personal meltdown. Mental health services are a critical link in the public health chain of defense against terrorist attacks.

People who are successfully coping with psychiatric disorders show us how to live with the demons of fear and despair -- and live well. They also show us how much more needs to be done.

"Now a whole nation knows what trauma is all about. It's a hard lesson. There's no simple medication that will make you not be fearful," says Coopper. "People need to feel safe and secure. People with serious mental illness haven't had that for a long time. Now the rest of society is joining us."

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